Cancer Patients Should Consider their Options before Choosing a Medicare Plan

Marc L. Goldwein OncoLink

As of 2006, new legislation will provide seniors and people with disabilities with the first comprehensive prescription-drug benefit ever offered under the Medicare program. The so-called "Medicare Part D" plan will offer people who qualify for Medicare the option of enrolling in a prescription drug plan.

Those who enroll can choose from a variety of government-approved plans offered by insurance companies and other private organizations. Participants will pay a monthly premium (around $35), as well as a deductible to cover payment of their first $250 of prescription drugs. They will then pay 25% of the next $2000, at which point regular coverage ends. Once total drug costs reach $5,100, catastrophic coverage takes care of 95% of all additional drug costs.

Created through a compromise between President Bush and 11 Senate Democrats in 2003, coverage of prescription drugs has received considerable praise from both parties.

"This is the end of a Medicare program that forces seniors to choose between food on the table and the medicine that they need," explained Democratic Senator John Breaux after the passage of the Medicare Prescription Drug Modernization Act. Republican Senate Majority Leader and physician Bill Frist concurred, calling it "epochal in the sense [that] it modernizes Medicare to provide 21st century care for our seniors."

Still, the program has been extremely controversial. A number of Democrats have argued that the bill falls short, failing to bring down prescription drug prices and offering considerable profit for drug companies. Republicans, meanwhile, have called the program an unnecessary expansion of Medicare, ballooning the deficit and costing the federal government over $600 billion.

President Bush has responded to some of these concerns, arguing that free-market competition between plans will bring down overall prices, and that drug coverage can actually reduce the liabilities of Medicare Part A and Part B.

"In the past, Medicare would pay more than $100,000 to treat the effects of a stroke, but not $1,000 per year for blood-thinning drugs that could have prevented the stroke in the first place," explained Bush. "With this new prescription drug benefit, Medicare will now help pay for the prescription drugs that can prevent serious illness."

On top of concerns with the bill, some have presented worry over implementation of the drug plan. Seniors are encouraged to compare plans online, but many seniors lack convenient access to a computer or the Internet. Those who use the Medicare phone service have also experienced confusion.

The American Cancer Society warns cancer patients to carefully consider their options in choosing a plan, reminding them that physician-administered chemotherapy drugs are generally already covered by Medicare Part B. However, "the distinction between coverage for cancer drugs under Medicare Part B and Medicare Part D is blurred when it comes to oral anti-cancer drugs and oral anti-nausea drugs."

Medicare Part D is completely voluntary, and those who qualify must enroll by May 15, 2006. Coverage has already begun for those enrolled before December 31, 2005. More information can be found by visiting http://www.medicare.gov/pdphome.asp or calling 1-800-MEDICARE.